IU Indianapolis ScholarWorks :: Browsing by Subject "veterans"

Browsing by Subject "veterans"

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Care ally-assisted massage for Veterans with chronic neck pain: TOMCATT results
(Elsevier, 2024-07) Munk, N.; Daggy, J. K.; Slaven, J. E.; Evans, E.; Foote, T.; Laws, B.; Matthias, M. S.; Bair, M. J.; Health Sciences, School of Health and Human Sciences
Purpose Chronic neck pain (CNP) is prevalent and challenging to treat. Despite evidence of massage's effectiveness for CNP, multiple accessibility barriers exist. The Trial Outcomes for Massage: Care Ally-Assisted vs. Therapist Treated (TOMCATT) study examined a care ally-assisted massage (CA-M) approach compared to a waitlist control prior to a study design modification (WL-C0). Methods CA-M consisted of in-person training for veteran/care-ally dyads to learn a standardized 30-minue massage routine, instructional DVD, and printed treatment manual. Participants were to complete three care ally-assisted massage sessions weekly for 12-weeks. Outcomes collected at baseline, 1-, 3-, and 6-months included validated measures of neck pain severity and associated disability. Linear mixed-model approaches were used for analysis with 3-months as the primary outcome timepoint. Results Participants (N = 203) were 56.7 ± 14 years old, 75% White, 15% female, and 75% married/partnered. Among 102 CA-M participants, 45% did not attend the in-person training and subsequently withdrew from the study and were more likely to be younger (p = .016) and employed (p = .004). Compared to WL-C0, CA-M participants had statistically significant reductions in pain-related disability at 3-months (−3.4, 95%CI = [−5.8, −1.0]; p = .006) and 6-months (−4.6, 95%CI = [−7.0, −2.1]; p < .001) and pain severity at 3-months (−1.3, 95%CI = [−1.9, −0.8]; p < .001) and 6-months (−1.0, 95%CI = [−1.6, −0.4]; p = .007), respectively. Conclusion In this analysis, CA-M led to greater reductions in CNP with disability and pain severity compared to WL-C0, despite treatment engagement and retention challenges. Future work is needed to determine how to better engage Veterans and their care-allies to attend CA-M training.
Consumer and Relationship Factors Associated with Shared Decision-Making in Mental Health Consultations
(2014-12) Matthias, Marianne S.; Fukui, Sadaaki; Kukla, Marina; Eliacin, Johanne; Bonfils, Kelsey A.; Firmin, Ruth; Oles, Sylwia; Adams, Erin L.; Collins, Linda A.; Salyers, Michelle P.; Department of Psychology, IU School of Science
Objective: This study explored the association between shared decision making and consumers’ illness management skills and consumer-provider relationships. Methods: Medication management appointments for 79 consumers were audio recorded. Independent coders rated overall shared decision making, minimum level of shared decision making, and consumer-provider agreement for 63 clients whose visit included a treatment decision. Mental health diagnoses, medication adherence, patient activation, illness management, working alliance, and length of consumer-provider relationships were also assessed. Correlation analyses were used to determine relationships among measures. Results: Overall shared decision making was not associated with any variables. Minimum levels of shared decision making were associated with higher scores on the bond subscale of the Working Alliance Inventory, indicating a higher degree of liking and trust, and with better medication adherence. Agreement was associated with shorter consumer-provider relationships. Conclusions: Consumer-provider relationships and shared decision making might have a more nuanced association than originally thought.
Effect of Health Information Exchange Plus a Care Transitions Intervention on Post-Hospital Outcomes Among VA Primary Care Patients: a Randomized Clinical Trial
(Springer, 2022-02-23) Boockvar, Kenneth S.; Koufacos, Nicholas S.; May, Justine; Schwartzkopf, Ashley L.; Guerrero, Vivian M.; Judon, Kimberly M.; Schubert , Cathy C.; Franzosa, Emily; Dixon, Brian E.; Epidemiology, Richard M. Fairbanks School of Public Health
Background Health information exchange (HIE) notifications when patients experience cross-system acute care encounters offer an opportunity to provide timely transitions interventions to improve care across systems. Objective To compare HIE notification followed by a post-hospital care transitions intervention (CTI) with HIE notification alone. Design Cluster-randomized controlled trial with group assignment by primary care team. Patients Veterans 65 or older who received primary care at 2 VA facilities who consented to HIE and had a non-VA hospital admission or emergency department visit between 2016 and 2019. Interventions For all subjects, real-time HIE notification of the non-VA acute care encounter was sent to the VA primary care provider. Subjects assigned to HIE plus CTI received home visits and telephone calls from a VA social worker for 30 days after arrival home, focused on patient activation, medication and condition knowledge, patient-centered record-keeping, and follow-up. Measures Primary outcome: 90-day hospital admission or readmission. Secondary outcomes: emergency department visits, timely VA primary care team telephone and in-person follow-up, patients’ understanding of their condition(s) and medication(s) using the Care Transitions Measure, and high-risk medication discrepancies. Key Results A total of 347 non-VA acute care encounters were included and assigned: 159 to HIE plus CTI and 188 to HIE alone. Veterans were 76.9 years old on average, 98.5% male, 67.8% White, 17.1% Black, and 15.1% other (including Hispanic). There was no difference in 90-day hospital admission or readmission between the HIE-plus-CTI and HIE-alone groups (25.8% vs. 20.2%, respectively; risk diff 5.6%; 95% CI − 3.3 to 14.5%, p = .25). There was also no difference in secondary outcomes. Conclusions A care transitions intervention did not improve outcomes for veterans after a non-VA acute care encounter, as compared with HIE notification alone. Additional research is warranted to identify transitions services across systems that are implementable and could improve outcomes.
Effect of Lean Processes on Surgical Wait Times and Efficiency in a Tertiary Care Veterans Affairs Medical Center
(AMA, 2017-01) Valsangkar, Nakul P.; Eppstein, Andrew C.; Lawson, Rick A.; Taylor, Amber N.; Department of Surgery, School of Medicine
Importance There are an increasing number of veterans in the United States, and the current delay and wait times prevent Veterans Affairs institutions from fully meeting the needs of current and former service members. Concrete strategies to improve throughput at these facilities have been sparse. Objective To identify whether lean processes can be used to improve wait times for surgical procedures in Veterans Affairs hospitals. Design, Setting, and Participants Databases in the Veterans Integrated Service Network 11 Data Warehouse, Veterans Health Administration Support Service Center, and Veterans Information Systems and Technology Architecture/Dynamic Host Configuration Protocol were queried to assess changes in wait times for elective general surgical procedures and clinical volume before, during, and after implementation of lean processes over 3 fiscal years (FYs) at a tertiary care Veterans Affairs medical center. All patients evaluated by the general surgery department through outpatient clinics, clinical video teleconferencing, and e-consultations from October 2011 through September 2014 were included. Patients evaluated through the emergency department or as inpatient consults were excluded. Exposures The surgery service and systems redesign service held a value stream analysis in FY 2013, culminating in multiple rapid process improvement workshops. Multidisciplinary teams identified systemic inefficiencies and strategies to improve interdepartmental and patient communication to reduce canceled consultations and cases, diagnostic rework, and no-shows. High-priority triage with enhanced operating room flexibility was instituted to reduce scheduling wait times. General surgery department pilot projects were then implemented mid-FY 2013. Main Outcomes and Measures Planned outcome measures included wait time, clinic and telehealth volume, number of no-shows, and operative volume. Paired t tests were used to identify differences in outcome measures after the institution of reforms. Results Following rapid process improvement workshop project rollouts, mean (SD) patient wait times for elective general surgical procedures decreased from 33.4 (8.3) days in FY 2012 to 26.0 (9.5) days in FY 2013 (P = .02). In FY 2014, mean (SD) wait times were half the value of the previous FY at 12.0 (2.1) days (P = .07). This was a 3-fold decrease from wait times in FY 2012 (P = .02). Operative volume increased from 931 patients in FY 2012 to 1090 in FY 2013 and 1072 in FY 2014. Combined clinic, telehealth, and e-consultation encounters increased from 3131 in FY 2012 to 3460 in FY 2013 and 3517 in FY 2014, while the number of no-shows decreased from 366 in FY 2012 to 227 in FY 2014 (P = .02). Conclusions and Relevance Improvement in the overall surgical patient experience can stem from multidisciplinary collaboration among systems redesign personnel, clinicians, and surgical staff to reduce systemic inefficiencies. Monitoring and follow-up of system efficiency measures and the employment of lean practices and process improvements can have positive short- and long-term effects on wait times, clinical throughput, and patient care and satisfaction.
Effects of the COVID-19 Pandemic on Black Veterans’ Mental Health: A Qualitative Investigation
(Johns Hopkins University Press, 2022-08) Matthias, Marianne S.; Adams, Jasma; Burgess, Diana J.; Daggy, Joanne; Gowan, Tayler M.; Perkins, Anthony J.; Eliancin, Johanne; Medicine, School of Medicine
Although the disproportionate effects of the COVID-19 pandemic on Black Americans are well-documented, we know little about its effects on their day-to-day lives and sense of wellbeing, especially for those who have served in the military. We conducted qualitative interviews with 21 Black veterans to understand their experiences with the pandemic and administered questionnaires about mental health and pandemic impact. Questionnaires indicated mild depression, moderate anxiety and loneliness, and pandemic effects on social support and health care. Interviews revealed that heightened anxiety and stress were driven by not trusting others to take the pandemic seriously, workplace anxiety, comorbidities, and the pandemic's pronounced effects on Black communities. Participants shared insights into these effects, including lack of caution on the part of some and the role of systemic racism. Findings enhance our understanding of how Black veterans have experienced the pandemic and may have important implications for other underserved groups.
Estimating and Reporting on the Quality of Inpatient Stroke Care by Veterans Health Administration Medical Centers
(2012-01) Arling, Greg; Reeves, Mathew; Ross, Joseph S.; Williams, Linda S.; Keyhani, Salomeh; Chumbler, Neale R.; Phipps, Michael S.; Roumie, Christianne L; Myers, Laura J.; Salanitro, Amanda H; Ordin, Diana L.; Myers, Jennifer; Bravata, Dawn M.
Background—Reporting of quality indicators (QIs) in Veterans Health Administration Medical Centers is complicated by estimation error caused by small numbers of eligible patients per facility. We applied multilevel modeling and empirical Bayes (EB) estimation in addressing this issue in performance reporting of stroke care quality in the Medical Centers. Methods and Results—We studied a retrospective cohort of 3812 veterans admitted to 106 Medical Centers with ischemic stroke during fiscal year 2007. The median number of study patients per facility was 34 (range, 12–105). Inpatient stroke care quality was measured with 13 evidence-based QIs. Eligible patients could either pass or fail each indicator. Multilevel modeling of a patient's pass/fail on individual QIs was used to produce facility-level EB-estimated QI pass rates and confidence intervals. The EB estimation reduced interfacility variation in QI rates. Small facilities and those with exceptionally high or low rates were most affected. We recommended 8 of the 13 QIs for performance reporting: dysphagia screening, National Institutes of Health Stroke Scale documentation, early ambulation, fall risk assessment, pressure ulcer risk assessment, Functional Independence Measure documentation, lipid management, and deep vein thrombosis prophylaxis. These QIs displayed sufficient variation across facilities, had room for improvement, and identified sites with performance that was significantly above or below the population average. The remaining 5 QIs were not recommended because of too few eligible patients or high pass rates with little variation. Conclusions—Considerations of statistical uncertainty should inform the choice of QIs and their application to performance reporting.
Evaluation of Stepped Care for Chronic Pain (ESCAPE) in Veterans of the Iraq and Afghanistan Conflicts A Randomized Clinical Trial
(AMA, 2015-05) Bair, Matthew J.; Ang, Dennis; Wu, Jingwei; Outcalt, Samantha D.; Sargent, Christy; Kempf, Carol; Froman, Amanda; Schmid, Arlena A.; Damush, Teresa M.; Yu, Zhangsheng; Davis, Louanne W.; Kroenke, Kurt; Department of Medicine, IU School of Medicine
IMPORTANCE: Despite the prevalence and the functional, psychological, and economic impact of chronic pain, few intervention studies of treatment of chronic pain in veterans have been performed. OBJECTIVE: To determine whether a stepped-care intervention is more effective than usual care, as hypothesized, in reducing pain-related disability, pain interference, and pain severity. DESIGN, SETTING, AND PARTICIPANTS: We performed a randomized clinical trial comparing stepped care with usual care for chronic pain. We enrolled 241 veterans from Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn with chronic (>3 months) and disabling (Roland Morris Disability Scale score, ≥7) musculoskeletal pain of the cervical or lumbar spine or extremities (shoulders, knees, and hips) in the Evaluation of Stepped Care for Chronic Pain (ESCAPE) trial from December 20, 2007, through June 30, 2011. The 9-month follow-up was completed by April 2012. Patients received treatment at a postdeployment clinic and 5 general medicine clinics at a Veterans Affairs medical center. INTERVENTIONS: Step 1 included 12 weeks of analgesic treatment and optimization according to an algorithm coupled with pain self-management strategies; step 2, 12 weeks of cognitive behavioral therapy. All intervention aspects were delivered by nurse care managers. MAIN OUTCOMES AND MEASURES: Pain-related disability (Roland Morris Disability Scale), pain interference (Brief Pain Inventory), and pain severity (Graded Chronic Pain Scale). RESULTS: The primary analysis included 121 patients receiving the stepped-care intervention and 120 patients receiving usual care. At 9 months, the mean decrease from baseline in the Roland Morris Disability Scale score was 1.7 (95% CI, -2.6 to -0.9) points in the usual care group and 3.7 (95% CI, -4.5 to -2.8) points in the intervention group (between-group difference, -1.9 [95% CI, -3.2 to -0.7] points; P=.002). The mean decrease from baseline in the Pain Interference subscale score of the Brief Pain Inventory was 0.9 points in the usual care group and 1.7 points in the intervention group (between-group difference, -0.8 [95% CI, -1.3 to -0.3] points; P=.003). The Graded Chronic Pain Scale severity score was reduced by 4.5 points in the usual care group and 11.1 points in the intervention group (between-group difference, -6.6 [95% CI, -10.5 to -2.7] points; P=.001). CONCLUSIONS AND RELEVANCE: A stepped-care intervention that combined analgesics, self-management strategies, and brief cognitive behavioral therapy resulted in statistically significant reductions in pain-related disability, pain interference, and pain severity in veterans with chronic musculoskeletal pain.
Factors Affecting Implementation of an Evidence-Based Practice in the VA: Illness Management and Recovery
(APA, 2015-12) McGuire, Alan B.; Salyers, Michelle P.; White, Dominique A.; Gilbride, Daniel J.; White, Laura M.; Kean, Jacob; Kukla, Marina; Department of Psychology, School of Science
Objective: Illness management and recovery (IMR) is an evidence-based practice that assists consumers in managing their illnesses and pursuing personal recovery goals. Although research has examined factors affecting IMR implementation facilitated by multifaceted, active roll-outs, the current study attempted to elucidate factors affecting IMR implementation outside the context of a research-driven implementation. Methods: Semi-structured interviews with 20 local recovery coordinators and 18 local IMR experts were conducted at 23 VA medical centers. Interviews examined perceived and experienced barriers and facilitators to IMR implementation. Data were analyzed via thematic inductive/deductive analysis in the form of crystallization/immersion. Results: Six factors differed between sites implementing IMR from those not providing IMR: awareness of IMR, importer-champions, autonomy-supporting leadership, veteran-centered care, presence of a sensitive period, and presence of a psychosocial rehabilitation and recovery center. Four factors were common in both groups: recovery orientation, evidence-based practices orientation, perceived IMR fit within program structure, and availability of staff time. Conclusions and Implications for Practice: IMR can be adopted in lieu of active implementation support; however, knowledge dissemination appears to be key. Future research should examine factors affecting the quality of implementation. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Factors impacting work success in Veterans with mental health disorders: A Veteran-focused mixed methods pilot study
(IOS, 2015) Kukla, Marina; Bonfils, Kelsey A.; Salyers, Michelle P.; Department of Psychology, School of Science
BACKGROUND: Veterans with mental illness often have poor employment outcomes. OBJECTIVE: This mixed-methods study sought to understand and describe Veteran perspectives of factors that impact their work success. METHODS: A sample of 40 employed and unemployed Veterans with post-traumatic stress disorder (PTSD) or other severe mental illness (SMI) completed a survey of factors that impact vocational functioning and provided narrative accounts of their most successful and challenging work experiences. RESULTS: Personal motivation, self-efficacy, work skills, interpersonal issues, health, and cognitive problems were rated as most impactful on work. There were no significant differences on ratings of work factors based on employment status. Veterans with PTSD reported significantly more barriers to work success compared with Veterans with SMI, notably, cognitive problems, physical health, and psychological stress. Veterans with SMI were more likely to receive VA vocational services and rated this assistance as beneficial to work success. Narrative findings corroborated the survey results, and yielded additional factors, including economic factors, person/job fit, and Veteran-specific issues. CONCLUSIONS: Several factors substantially impact work success in Veterans with mental illness. Veterans with PTSD and SMI experience a distinct set of barriers and facilitators, suggesting the need for tailoring clinical and rehabilitative services.
Factors influencing patients’ preferences and perceived involvement in shared decision making in mental health care
(Informa, 2015-02) Eliacin, Johanne; Salyers, Michelle P.; Kukla, Marina; Matthias, Marianne S.; Department of Psychology, IU School of Science
Background: Although research has suggested that patients desire to participate in shared decision-making, recent studies show that most patients take a passive role in their treatment decisions. The discrepancy between patients’ expressed desire and actual behaviors underscores the need to better understand how patients perceive shared decision-making and what factors influence their participation. Aims: To investigate patients’ preferences and appraisals of their involvement in treatment decisions. Methods: Fifty-four qualitative interviews were conducted with veterans receiving outpatient mental health care at a U.S. Veterans Affairs Medical Center. Interviews were analyzed using thematic analysis. Results: Participants outlined several factors that influence their preferences and involvement in treatment decisions. These include the patient–provider relationship, fear of being judged, perceived inadequacy, and a history of substance abuse. Conclusion: Patients’ preferences and willingness to engage in shared decision-making fluctuate over time and are context dependent. A better understanding of these factors and a strong patient–provider relationship will facilitate better measurement and implementation of shared decision-making.

Browsing by Subject "veterans"

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